Massive Pulmonary Hemorrhage due to Cytomegalovirus Infection in a Japanese Patient with Alpha-1-Antitrypsin-Deficient Emphysema

Tsushima, Kenji; Koyama, Shigeru; Takematsu, Hayato; Okada, Kazuyoshi; Hata, Satoru; Ichiyoshi, Takeo; Seyama, Kuniaki; Kubo, Keishi

doi:10.1159/000029393

Cited by 4 publications

(4 citation statements)

References 10 publications

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“…Although CMV infections are prevalent in the general population, symptomatic pneumonia in immunocompetent hosts is rarely reported [77]. In severe cases, massive hemorrhage with frank hemoptysis may occur [78]. Magro et al [10] described four previously healthy adults who developed subacute onset of respiratory symptoms temporally associated with serologic or culture evidence indicative of acute CMV infection.…”

Section: Other Infections Rarely Presenting With Dah In Immunocompetent Patientsmentioning

confidence: 99%

Infectious Diseases Causing Diffuse Alveolar Hemorrhage in Immunocompetent Patients: A State-of-the-Art Review

Ranke

Zanetti

Hochhegger

et al. 2012

Lung

111

101

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Diffuse alveolar hemorrhage (DAH) represents a syndrome that can complicate many clinical conditions and may be life-threatening, requiring prompt treatment. It is recognized by the signs of acute- or subacute-onset cough, hemoptysis, diffuse radiographic pulmonary infiltrates, anemia, and hypoxemic respiratory distress. DAH is characterized by the accumulation of intra-alveolar red blood cells originating most frequently from the alveolar capillaries. It must be distinguished from localized pulmonary hemorrhage, which is most commonly due to chronic bronchitis, bronchiectasis, tumor, or localized infection. Hemoptysis, the major sign of DAH, may develop suddenly or over a period of days to weeks; this sign may also be initially absent, in which case diagnostic suspicion is established after sequential bronchoalveolar lavage reveals worsening red blood cell counts. The causes of DAH can be divided into infectious and noninfectious, the latter of which may affect immunocompetent or immunodeficient patients. Pulmonary infections are rarely reported in association with DAH, but they should be considered in the diagnostic workup because of the obvious therapeutic implications. In immunocompromised patients, the main infectious diseases that cause DAH are cytomegalovirus, adenovirus, invasive aspergillosis, Mycoplasma, Legionella, and Strongyloides. In immunocompetent patients, the infectious diseases that most frequently cause DAH are influenza A (H1N1), dengue, leptospirosis, malaria, and Staphylococcus aureus infection. Based on a search of the PubMed and Scopus databases, we review the infectious diseases that may cause DAH in immunocompetent patients.

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Section: Other Infections Rarely Presenting With Dah In Immunocompetent Patientsmentioning

confidence: 99%

Infectious Diseases Causing Diffuse Alveolar Hemorrhage in Immunocompetent Patients: A State-of-the-Art Review

Ranke

Zanetti

Hochhegger

et al. 2012

Lung

111

101

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“…Compared to emphysema due to cigarette smoking, panacinar emphysema may result in very dilated and damaged alveolar spaces and dilated bronchi. Hemoptysis therefore can be encountered in some patients with panacinar emphysema [5]. Our suspicion may be supported by the fact that hemoptysis in otherwise healthy subjects is a quite rare event in such cases [6].…”

Section: Discussionmentioning

confidence: 95%

Massive Hemoptysis due to Mild and Focal Contusion on an Emphysematous Lung

Türüt¹

2011

Tur Toraks Der

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“…Related cases report either CMV infection or A1AT deficiency, however not presented in same patient ( 5 , 7 , 13 ). There has been report of comorbid presentation of A1AT deficiency and CMV infection in adult ( 24 ). Additionally, one reported case presented 2-month infant, PiMM phenotype with urinary CMV, but without signs of hepatic necrosis, infection or cirrhosis ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Unusually difficult clinical presentation of an infant suffering from congenital cytomegalovirus (CMV) infection combined with alpha 1-antitrypsin (A1AT) deficiency

et al. 2014

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Congenital Cytomegalovirus (CMV) infection and alpha 1-antitrypsin (A1AT) deficiency are separately well described entities, but their simultaneous occurrence can pose a special challenge to a clinician, especially dealing with optimal diagnostic as well as therapeutic approach. Congenital CMV infection is the most common vertically transmitted infection in developed countries. In 85–95% of newborns it runs asymptomatic, while in others it is presented with jaundice, petechias, hepatosplenomegaly and central nervous system damage. A1AT deficiency is on the other hand, the most common genetic liver disease in children, and the clinical spectrum varies from the accidentally detected increased levels of transaminases through to the severe infant cholestasis that can progress to cirrhosis. The following case report describes a two-month old male with severe clinical presentation of congenital CMV infection probably exacerbated due to A1AT deficiency comorbidity. The clinical manifestations and unusually difficult clinical signs this infant presented lead to assumption that the additional liver damage exists. Extensive laboratory analyses were performed, including PCR for CMV DNA, A1AT serum concentration, A1AT genotyping, followed and confirmed with phenotyping. Patient was treated parenteral with ganciclovir, what continued with oral valganciclovir and supportive therapy. Intensive and thorough supportive treatment of the infant resulted in satisfactory progress and excellent outcome. Patient was followed-up till the age of 18 months. The presented case provides excellent example about successful overcoming obstacles in differential diagnosis of A1AT in neonates and infants. Medical charts analysis was the methodology used in making this report.

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Massive Pulmonary Hemorrhage due to Cytomegalovirus Infection in a Japanese Patient with Alpha-1-Antitrypsin-Deficient Emphysema

Cited by 4 publications

References 10 publications

Infectious Diseases Causing Diffuse Alveolar Hemorrhage in Immunocompetent Patients: A State-of-the-Art Review

Infectious Diseases Causing Diffuse Alveolar Hemorrhage in Immunocompetent Patients: A State-of-the-Art Review

Massive Hemoptysis due to Mild and Focal Contusion on an Emphysematous Lung

Unusually difficult clinical presentation of an infant suffering from congenital cytomegalovirus (CMV) infection combined with alpha 1-antitrypsin (A1AT) deficiency

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